The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis

Kokkinidis, Damianos G.; Papanastasiou, Christos A.; Jonnalagadda, Anil Kumar; Oikonomou, Evangelos; Theochari, Christina A.; Palaiodimos, Leonidas; Karvounis, Haralambos; Faillace, Robert T.; Giannakoulas, George

doi:10.1016/j.carrev.2018.03.015

Cited by 21 publications

(28 citation statements)

References 38 publications

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“…Our findings are in accordance with previous reports on PH and outcomes in patients with AS after TAVR and suggest that despite the novel definition, PH preserves its prognostic significance [ 3 , 4 , 13 , 14 , 15 ]. Moreover, in a recent study by Maeder et al, despite a slight reclassification effect, PH remained a significant determinant of all-cause mortality.…”

Section: Discussionsupporting

confidence: 93%

Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement

Adamopoulos

Pagoulatou

Rovas

et al. 2022

JCM

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Introduction: Pulmonary hypertension (PH), traditionally defined as a mean pulmonary artery pressure (PAP) ≥ 25 mmHg, is associated with poor outcomes in patients undergoing a transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Recently, a novel definition for PH has been proposed, placing the cut-off value of mean PAP at 20 mmHg, and introducing pulmonary vascular resistance as an exclusive indicator for the pre-capillary involvement. In light of the novel criteria, whether PH still preserves its prognostic significance remains unknown. Methods: The study population consisted of 380 patients with AS, who underwent a right heart catheterization before TAVR. The cohort was divided according to the presence of PH (n = 174, 45.7%) or not. Patients with PH were further divided into the following groups: (1) Pre-capillary PH ((Pre-capPH), n = 46, 12.1%); (2) Isolated post-capillary PH ((IpcPH), n = 78, 20.5%); (3) Combined pre and post-capillary PH ((CpcPH), n = 82, 21.6%). The primary endpoint was all-cause mortality at 1 year. Results: A total of 246 patients (64.7%) exhibited mean PAP > 20 mmHg. Overall, the presence of PH was associated with higher 1-year mortality rates (hazard ratio (HR) 2.8, 95% CI: 1.4–5.8, p = 0.004). Compared to patients with no PH, Pre-capPH and CpcPH (but not IpcPH) were related to higher 1-year mortality (HR 2.7, 95% CI: 1.0–7.2, p = 0.041 and HR 3.9, 95% CI: 1.8–8.5, p = 0.001, respectively). This remained significant even after the adjustment for baseline comorbidities. Conclusions: Pre-interventional PH according to the novel hemodynamic criteria, is linked with poor outcomes in patients undergoing TAVR for severe AS. However, this is mainly driven by patients with mean PAP ≥ 25 mmHg. Patients with a pre-capillary PH component as defined by increased PVR present an even worse prognosis as compared to patients with isolated post-capillary or no PH who present comparable 1-year mortality rates.

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Section: Discussionsupporting

confidence: 93%

Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement

Adamopoulos

Pagoulatou

Rovas

et al. 2022

JCM

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“…In earlier studies, pulmonary hypertension at baseline has been reported as a predictor of mortality. 17 A high mean aortic valve gradient was associated with decreased risk for repeated hospitalizations or death. However, only moderate or high mean aortic valve gradient with preserved left ventricular function was found to be prognostic for decreased risk for hospitalizations whilst no such effect was found for patients with concomitant impaired left ventricular function.…”

Section: Discussionmentioning

confidence: 99%

Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Nilsson

Buccheri

Christersson

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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Aim The aim of this study was to investigate the pattern, causes and predictors of all new hospitalizations in patients who underwent TAVI. Methods and results The nationwide Swedish TAVI-registry was merged with other mandatory health care registries, which enabled the analysis of all TAVI-procedures, new hospital admissions and death between the years 2008 and 2017. A total of 2821 patients underwent TAVI with a mean of 2.5 hospitalizations during a mean Follow-up of 2.2 years. Hospitalizations were associated with worse prognosis. Heart failure (HF) was the most common cause of hospitalization with 19% having at least one hospitalization due to HF causing 16% of all-cause admissions and 50% of cardiovascular admissions. Male gender, age > 90 years, high Charlson Comorbidity Index, atrial fibrillation, present neurologic disease, severe renal impairment, peripheral vascular disease, New York Heart Association class IV, mild or moderate mean aortic valve gradients and pulmonary hypertension were associated with an increased risk for all-cause hospitalizations or death. For cardiovascular hospitalization or death, the pattern was similar, with the addition of impaired systolic left ventricular function as a predictor. Conclusion Multiple hospitalizations after TAVI are common, and are often caused by HF. Reducing the rate of HF hospitalizations is important to mitigate the burden on the health care system due to new hospitalizations after TAVI.

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“…Tricuspid annulus dilatation and TR compound pulmonary hypertension (PH) with resultant pressure overload, and baseline PH predicts impaired outcomes after TAVI. A meta‐analysis by Kokkinidis et al of 22 studies showed that baseline PH was associated with increased late (>6‐month) cardiac and all‐cause mortality after TAVI. Also in a meta‐analysis by Tang et al of 16 studies enrolling 9,204 patients, baseline PH was a predictor of increased (1) 30‐day all‐cause and cardiovascular mortality and incidence of acute kidney injury; (2) 1‐year all‐cause and cardiovascular mortality and incidence of stroke; and (3) 2‐year all‐cause mortality after TAVI.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

Takagi

Hari

Kawai

et al. 2018

Cathet Cardio Intervent

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Objectives To determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic‐valve implantation (TAVI), we performed a meta‐analysis of currently available studies. Methods MEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in‐hospital or 30‐day) and late (including early) all‐cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non‐significant (typically, ≥moderate versus

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The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis

Cited by 21 publications

References 38 publications

Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement

Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement

Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

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